Module 9 - AEFI Flashcards
If a patient develops cold symptoms after a vaccine, is it likely that it was caused by the vaccine?
No - most likely due to a viral infection
What are the most common types of AEFI ?
minor local reactions such as pain, swelling, and redness at the site of injection
What causes minor local reactions such as pain, swelling, and redness at the site of injection?
either due to high titres of antibody or through the irritation of the tissues due to the process of injecting a foreign material
When do minor local reactions usually begin?
within a few hours after vaccination
What can you recommend to patients to ease their discomfort due to minor local reactions such as pain, swelling, and redness at the site of injection?
- cold compresses
- acetaminophen
Are minor local reactions a contraindication for further doses of the vaccine ?
NO - the recurrence risk is moderate and declines with the length of interval between doses
Describe an Arthus reaction
- large and more severe than local reactions to a vaccine
- characterized by pain, swelling, induration (tissue that becomes firm) and edema
- usually begins 2-12 hours following immunization and develops gradually over a period of hours
Why are Arthus reactions formed?
- believed to occur due to the presence of a large amount of circulating antibody prior to injection of the vaccine and the formation antigen-antibody immune complexes
- these complexes deposit in the walls of blood vessels, resulting in intense mobilization and leakage of white blood cells
- red blood cells also leak into the surrounding tissues
- results in massive swelling at site of injection that may involve the entire limb
Is an Arthus reaction considered an allergic reaction?
NO
What can we recommend to ease discomfort for an Arthus reaction?
- cold compresses
- acetaminophen
- limb elevation
*to reduce pain and swelling
How long do Arthus reactions usually last?
1 week
Can subsequent doses of vaccine be given to a child less than 6 months of age who got an Arthus reaction with the initial dose of vaccine?
No - deferral of subsequent doses of the same vaccine for several months is indicated
How do you manage if an Arthus reaction occurred during a tetanus toxoid booster?
Future boosters may need to be spaced at longer intervals and antitoxin levels may require monitoring prior to the injection of the next booster.
Nodules following immunization are mainly associated with vaccines containing ________-based adjuvants
aluminum
When are nodules very common?
When the immunizer deposits the vaccine contents SC rather than IM
How long can nodules last for?
Up to a year - they are rarely permanent
Are nodules allergic in origin?
NO
What can we recommend for nodules?
analgesic and ice to injection site will provide relief of pain
*in some situations, drainage of the nodule may be required
If a pt develops a nodule, can they receive further doses of the vaccine?
Yes - no deferral of subsequent vaccines is necessary.
*Use an alternate site for the next dose and ensure proper technique and correct needle length for IM injections
Fever that does not being until ______ hours after vaccination with inactivated vaccines should not be assumed to be due to the vaccine.
more than 24
Fevers can increase the risk of ???
febrile seizures
Are febrile seizures serious?
They have an excellent prognosis without any long-term problems. But they may decrease a parent’s faith in the immunization system.
_____ is drug of choice for treating fever post-immunization
Acetaminophen
What is the dose for acetaminophen?
15 mg/kg/dose every 4-5 hours (max 5 doses/day)
Is fever a contraindication to further doses of the vaccine?
No - the chance of recurrence is moderate
Should parents give children acetaminophen before a vaccine in case they develop a fever?
No - it should only be given if they develop a fever (or pain at site of injection)
___ vaccines produce a low-grade infection which can include adenopathy (lymph node enlargement)
Live
With any immunization, if ______ contaminate the infection site, it can lead to inflammation of lymph nodes
bacteria
When would adenopathy be considered severe?
when at least one lymph node > 1.5 cm in diameter
How do you manage further doses of the vaccine where adenopathy had developed?
continue with further immunizations at a different injection site
Do allergic reactions ever happen with the initial dose of a vaccine?
No - an allergic rxn is an acquired hypersensitivity to an antigen that is normally tolerated in most individuals. it can occur in response to a component of a vaccine in a person previously sensitized
If anaphylaxis is suspected, ______ is drug of choice
epinephrine
For severe allergic reactions, what can also be administered along with epinephrine?
- bronchodilators (ex. salbutamol)
- antihistamines such as diphenhydramine can help for hives and itching associated with the reaction
Is this likely linked to vaccine:
Hives occurring within less than 2 hours of the vaccine?
How are further doses managed?
Yes - refer to an allergist for assessment prior to further doses of the same vaccine or its components
Is this likely linked to vaccine:
Hives occurring after 2 hours of the vaccine?
How are further doses managed?
The link to vaccine is less likely.
- Continue with subsequent immunizations but observe for 2 hours after next immunization of the same type
- Consider giving the next dose in an emergency room or physicians’ office
- If there is no reaction with next dose, continue regular dosing schedule
*If rash appears within 48 hours after the next dose, then referral to an allergist is recommended
Is this likely linked to vaccine:
Hives occurring after 48 hours of the vaccine?
How are further doses managed?
This reaction is unlikely to be linked to the vaccine.
-Subsequent immunizations can be given under normal conditions
Rashes are quite common with what vaccines?
MMR and MMRV
What is the rash caused by?
mild measles-like illness caused by the vaccine and appears as a generalized rash and fever
When dose the rash occur?
7-10 days after vaccination
How common is the MMR or MMRV rash?
5-10% of patients receiving first dose
Is it more or less common with the second dose?
less
What can we recommend for the rash?
oral antihistamines may help lessen the symptoms
Are rashes further contraindications to further doses of a vaccine?
NO
Hypotonic-Hyporesponsive (HH) episodes can occur following immunization with any whole-cell _____ containing vaccine
pertussis
HH episodes are most commonly in children how old?
under 2 years old
How do HH episodes affect patients?
- acute decrease in sensory awareness
- loss of consciousness with pallor
- decrease in muscle tone in infants
- children may become irritable and febrile
- they then become pale, limp and unresponsive and respirations are shallow and cyanosis is frequently reported
When do HH episodes occur after vaccines?
between 1-12 hours after immunization
How long do HH episodes last?
only a few minutes and are self-limiting although it may be as long as 36 hours before the child returns to normal
Is there anything we can recommend to treat HH episodes?
No
Is an HH episode a contraindication to an acellular pertussis vaccine?
No
How do we define acute encephalopathy? (3)
1 - severe alteration in level of consciousness or unresponsiveness, with or without generalized or focal convulsions
2 - increased intracranial pressure
3 - distinct change in behaviour or intellectual functions lasting one day or more
Most of the studies linking immunization with encephalopathy were done with what kind of vaccine?
whole-cell pertussis-containing vaccines
______ pertussis vaccines are much less likely to cause serious adverse events.
Acellular
What is the treatment for encephalopathy?
supportive therapy in hospital
Is encephalopathy a contraindication to further vaccinations?
No - but deferral of pertussis immunization may be considered until the neurological condition has been diagnosed or is stable
What is encephalitis?
An inflammatory condition of the brain characterized by headache, neck pain, fever, nausea and vomiting. Neurological disturbances may occur, including seizures, personality changes, irritability, lethargy, paralysis, weakness and coma
There has been a causal relationship between ____________ vaccine and encephalitis
whole cell pertussis
Is there a link between acellular pertussis vaccine and encephalitis?
No - there has not been a single reported case
Encephalitis occurs rarely after ______ _____ vaccine in young infants and thus it should not be used in infants < 4 months of age.
yellow fever
How is encephalitis treated?
supportive therapy in hospital
Is encephalitis a contraindication to further vaccines?
YES - defer further vaccines until a diagnosis is made as to the cause of the encephalitis
What is Guillain-Barre Syndrome (GBS) ?
it is a subacute, usually symmetrical ascending paralysis, with sensory disturbances
There is limited evidence of an association between _______ ______ and GBS and ____ ____ _______ and GBS
tetanus toxoid
oral polio vaccine
Is GBS a contraindication to further doses of the vaccine?
Yes
What does Oculo-Respiratory Syndrome (ORS) cause?
bilateral red eyes or facial swelling or respiratory symptoms such as cough, wheeze, sore throat, chest tightness, difficulty breathing, difficulty swallowing, hoarseness or sore throat within 24 hours of influenza vaccine
What vaccine is linked to ORS?
influenza vaccine
When do ORS symptoms resolve?
within 48 hours
Is ORS considered allergic?
No
Is ORS considered a CI for further influenza vaccines?
No
If a patient faints and remains unconscious for more than 2-3 minutes, how do you proceed?
with anaphylaxis treatment protocol
What is CAEFISS and what is it responsible for?
Canadian Adverse Events Following Immunization Surveillance System:
- voluntary and passive surveillance system
- people report AEFI to this system
What is IMPACT?
Immunization Monitoring Program Active:
-in this program, a nurse at each of the main children’s teaching hospitals in Canada actively reviews all admissions to the hospital for certain serious illnesses such as seizures, encephalitis, encephalopathy and acute paralysis
Describe the W5 for reporting AEFI
Why to report Who should report When to report What to report Where to find the AEFI report form
